Mhasibu Sacco Society Limited,

Market Street, ABSA Towers, 8th Floor,

P.O. Box 31295, 00600, Nairobi Kenya
Tel: +254 020-5141900
Email: info@mhasibusacco.com.
Website: https:/www.mhasibusacco.com

LOAN APPLICATION FORM

Membership No. MHS…………… Loan Reg. No. L…………

PERSONAL CHECKLIST
BUSINESS MEMBER SALARIED MEMBERS COLLATERAL OPTIONS
☐ ID/Passport ☐ ID/Passport ☐ Original documents; -logbook/title deed/MHCL certificate
☐ PIN certificate ☐ PIN certificate ☐ Copy of car insurance sticker
☐ Referee & Guarantors IDs/Passports ☐ Referee IDs ☐ Unit trust statement
☐ Certified Bank statements for the last 12 months for registered business ☐ Guarantors IDs / Passports ☐ Original Insurance policy
☐ Certified Bank statement for the last 2years for unregistered business ☐ Pay slips for the last 3 months (certified by employer) ☐ MICL pledge letter
☐ Authority to use Bank statement by the other directors/Partners ☐ Certified Bank statements for the last 3 months (salary A/C) ☐ CHS Birth certificate & Endorsement Letter
☐ Certificate of Incorporation /Registration & Business permit ☐ Self guaranteed to provide either of statements or payslips ☐ Signed guarantorship forms and ID copies
☐ CR 12 for limited companies /Partnership
☐ Declaration of Income and Expenditure for one year

*Please complete this form in block capitals, also note Incomplete forms will be returned unconsidered.

1. MY PERSONAL DETAILS

Name: …........................................................................................... ID No: ........................................... PIN No: .............................................

Personal Email Address: ….............................................................. Mobile No: …................................ Marital Status:………………………
Current Postal Address: …………................................................... Code: ..........................................................................................................
Physical Location: ……...…............................................................. Nearest Public Institution: ........................................................................
Street/Lane: ...................................................................................... Plot No./ House No: ..................................................................................

2. AMOUNT APPLIED (In figures): Kshs :....................................................... (In words) .............................................................................

.................................................................................................................................................................................................................................

3. LOAN TYPE.
☐ Normal ☐ Gold ☐ Top-up ☐ Swift ☐ Asset ☐ Plot Buying ☐ Multi
Repayment period .......................................... Offset existing Loans (Specify) ..................................................................................
Purpose of the loan …...........................................................................................................................................................................................

4. MODE OF PAYMENT: ☐ Check off ☐ Direct Debit ☐ Standing Order ☐ Mpesa ☐ Others (Specify) ....................................

5. SECURITY OFFERED FOR THE LOAN (Attach Original Document (s) where applicable)
☐ Deposit 100% ☐ Logbook ☐ NSE Shares 50% ☐ Children Scheme 100% ☐ MHCL Title/Completion Certificate ☐ Other Titles
(Urban) 60%, (Rural) 40% ☐ Unit Trust 100% ☐ Fixed Deposit 100% ☐ Insurance Life Policy 100%

6. DISBURSEMENT MODE: BANK OR MOBILE TRANSFER

*I am authorizing your office to transfer my loan amount to the following Bank/M-pesa details (Funds will be net of bank charges and loan
balances being offset and other incidental costs) ☐ EFT ☐ RTGS ☐ M-pesa
Account Name.............................................................................................................. Bank................................................................................
Branch ......................................................................................................................... Account No. ..................................................................
Mobile Name (For Mpesa Only) ................................................................................ Mobile No. ....................................................................

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7. EMPLOYMENT DETAILS
Name of employer......................................................................... No. of years with Employer: ....................................................................
Department................................................................................... Position......................................................................................................
Work physical address.................................................................. Telephone (Work) .....................................................................................

8. BUSINESS DETAILS (Business members only)

Name of business: .................................................................Type of business: ...................................Registration No: ..................................

PIN No: .......................................Years in operation ..............Telephone No ...................................Physical location ....................................

9. REFEREES (One referee must be a relative)

Referee 1 Referee 2 (Must be a relative)

Full Name
Relationship
Tel: (Home/ Mobile)
Email Address

10. LOANS WITH OTHER FINANCIAL INSTITUTIONS

Name of the Financial Institution Principal Amount Installment Amount (per Month) Current Balance

11. LOAN GUARANTEE (Read and understand before signing)

I/We, the undersigned acting as guarantors for the loan requested on page 1 of this application form understand and agree jointly and severally
that all deposits with Mhasibu Sacco Society Ltd, owned by me/us-are hereby pledged as security for the said loan. The applicant hereby agrees
that if the securities are not enough the personal belonging shall form guarantee of the loan balance and should be attached. In case of default in
repayment by the loanee the management is hereby authorized to deduct any balance interest and cost appertaining to the loan from the securities
hereby pledged. Our details are as provided below:

Complete this part in block capitals: Guarantors' name should be written in full.

AMOUNT
GUARANTEED
MEMBER NO. MEMBER NAME PHONE NO. (Please indicate SIGNATURE DATE
amount)

Please note the amount guaranteed must be indicated

COMMUNICATION TO DEFAULTERS

Incase of default the communication to the guarantor and the Applicant will be as follows;
i) First month notification will be by Email to the loan Applicant.
ii) Second month notification will be to both the Applicant and the guarantors through an Email.
iii) Third month default will be communicated through email to member and guarantors.

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12. TERMS & CONDITIONS

I understand that the basic rules applicable to this application are as Listed and understand the loan will be granted only according to these rules.
i) Members are limited to four times (or as may be prescribed) the sum of shares and deposit held, but subject to availability of funds.
For self-guaranteed loans only, uncommitted deposits shall be considered.
ii) 2/3 rule shall apply in the loan appraisal.
iii) A member will be required to maintain a monthly deposit contribution depending on loan repayment period and amount
contribution subject to the current requirements based on loan applied for as shown below:
Loans Amount (Kshs) Up to 48 Months Beyond 48 Months
Minimum Contribution (Kshs) Minimum Contribution (Kshs)
Up to 500,000 1,600 2,000
500,001 - 1,000,000 1,600 4,000
1,000,001 - 1,500,000 2,000 5,000
1,500,001 - 2,000,000 3,000 7,500
2,000,001 - 3,000,000 6,000 10,000
3,000,001 - 4,000,000 10,000 15,000
4,000,001 - 50,000,000 15,000 20,000

iv) Outstanding loans must have been cleared/ offset before a new loan is granted OR the member allows the Sacco to offset the
outstanding loans as per the standing policy guiding respective loan products.
v) Members must have contributed for a minimum period of six consecutive months having a minimum share/deposit contribution
vi) The guarantors must be members of the society, one can guarantee a maximum of 7 loans including theirs.
vii) Lumpsum contribution for the purpose of securing a loan can be considered only if such money remains in the Society for at least six
months, OR subject to a commission between 10% to 40% commission on the lumpsum for members in good standing.
viii) In case of default in payment the entire balance of the loan will immediately become due and payable at the discretion of the Board
and all deposits owned by the member and held by the member and any interest and deposits due to the member will be set against
the owed amount. The member will also be liable for any costs incurred in the agencies so appointed for the loan balance and
accumulated interest. Any remaining balance will be deducted from the member's salary and or terminal benefits and the employer is
authorized to make all necessary deduction by authority of the member's signature appended below.
ix) Members applying for loans above 5 million shall be required to provide additional security besides the guarantors as maybe
prescribed from time to time.
x) Members shall be required to provide email address of their bank for validation of bank statements for loans of KES. 1 million and
above.
xi) All loan applicants of amounts KES. 200,000 and above will be expected to sign a direct debit Authority Form for payment.

13. MEMBER DECLARATION

i) Notwithstanding the credit facility. I/We understand that Mhasibu Sacco Society Ltd shall obtain credit report from Credit
Reference Bureau (CRB) as may be required in certain circumstances at the discretion of the Board and share my loan
performances with the CRB.
ii) I hereby declare that the foregoing is true to the best of my knowledge and belief and I agree to abide by the by laws of the
society, the credit policy and any variations by the board in respect to above sections. l/we further confirm that, l/we understand
that in case of default, the defaults information will be furnished to a CREDIT REFERENCE BUREAU, ICPAK, KASNEB,
Other relevant bodies/institutions without prior written consent.*
*Mhasibu Sacco lists all loans with CRBs, non-performing loans will be listed as loans in default.
Applicant:

Name.................................................................. Signature........................................................ Date: .........................................................

Witnessed by:

Name ..................................................................Signature .........................................................Membership No/ ID No. ..........................

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IRREVOCABLE INSTRUCTIONS (For members’ deductions through employer’s payroll)

TO THE EMPLOYER

Name of the Organization: ……………………………………………………………………………………………………

MEMBER'S SECTION

IRREVOCABLE INSTRUCTIONS FOR LOAN REPAYMENT

I .......................................................................................... Employer's No ................................ hereby authorize and request you to deduct

from my salary each pay day the sum of shillings (Kshs)....................................................... (in words) ..........................................................
……......................................................................................................................................................................................................................

LOAN REPAYMENT TERMS

Loan repayment (Principal + Interest) Deposit (matched to loan amount) Total

With effect from ...................20...............to...............20................ to be paid to Mhasibu Sacco Limited and that in the event of my leaving the

institution, my terminal dues equivalent to outstanding loan balance be withheld until a letter of clearance is received from Mhasibu Sacco

Limited. These instructions shall be terminated or amended only with knowledge and written approval of the Board of Mhasibu Sacco limited.

Members Signature: …………………………….………... Membership Number: …………….……….. Date: …………………

EMPLOYER'S SECTION (Acknowledgment of irrevocable Instructions)

Name ...................................................................................................................................Signature ................................................................

Date .................................................................................................................................................... ................................................................

Designation .........................................................................................................................................................................................................

OFFICIAL RUBBER STAMP

SOCIETY'S SECTION

(For official use only)

Received By:

Name: ........................................................................................... Signature: ..................................................................................................

Date .................................................................................................Time ........................................................................................................

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 Mhasibu Sacco Society Limited,
Market Street, ABSA Towers, 8th Floor,
P.O. Box 31295, 00600, Nairobi Kenya
Tel: +254 020-5141900
Email: info@mhasibusacco.com.
Website: https:/www.mhasibusacco.com

DIRECT DEBIT AUTHORITY FORM

Member Details Beneficiary details
To Name: MHASIBU SACCO SOCIETY LTD
Bank Name: ………………………………………… Bank Name: Co-operative Bank of Kenya Ltd
Bank Code: ………………………………………… Branch: Co-operative Bank House, Nairobi
Branch Name: ………………………………………… Branch Code:11031
A/c No: ………………………………………… Account to be credited: 01120040136100
Membership No: ………………………………………… Originator Code: 1235

Member’s Name: ……………………………………………………………. ID No. ………………………………….

Address: ……………………………………………………………. TeI No. ………………………………….

I/We hereby request, instruct and authorize you to draw against my/ our account with the above mentioned bank or any other bank or branch
to which I/ We may transfer my/ our account the sum of Kshs ………………… (amounts in words) ………………………………………..
…………………. ………………………………………………………………………………………………………………………….……
the amounts necessary for payment of the monthly installment/premium due in respect of the above-mentioned agreement/Sacco on the ……
day of each month commencing on ……………… and continuing (as the case may be). All such withdrawals from my/our account by you
shall be treated as though they have been signed by me/us personally.

The amounts are variable and may be debited on various dates. I/We understand that you may change the amount and dates only after giving
me/us prior notice.

I /We understand that the withdrawals hereby authorized will be processed by Direct Debit transfers and I /We also understand that details of
each withdrawals will be printed on my bank statement or an accompanying voucher. I/we agree to pay any bank charges relating to this
authority.

This authority may be cancelled by me /us giving you 30 (thirty) days’ notice in writing, sent by prepaid registered post or delivered to the
offices of the above mentioned company/ association but I /We understand that I /We shall not be entitled to any amounts which you have
already withdrawn while this authority was in force if such amounts were legally owing to you.

Receipt of this Authority by you shall be regarded as receipt thereof by my/ our bank (whichever it is or will be). I/ We understand that if any
Direct Debit Transfer is paid which breaks the terms of this authority, you will make a refund upon application.

Sign .................................................................... Date …………………….

(Member’s Signature as used for signing cheques)

Witnessed By…………………………………….. (MHASIBU SACCO STAFF)

Sign……………………………………………………

For Bank use only:

Confirm Bank Details & Signature:……………………………………. Approved By:………………………………….

Date Stamp:

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